Individual provider Active NPI

Timothy J Luke, FNP-C

  • Family Nurse Practitioner
  • Tifton, GA
National Provider Identifier
1558177089
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN245394 Issued in GA
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 353-7501
NPI assigned
Dec 9, 2024
Last updated
Oct 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN245394 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

108 Sunnydale CV
Thomasville, GA 31757-4049
Phone (229) 520-1269

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250802000375 GA Practitioner - Nurse Practitioner 6305354168 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN245394GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Georgia Radiology Associates, LLC CurrentSince Apr 20, 2025 Accepting new patients
Bca Georgia, LLC Past Accepting new patients

Locations

163 E Tollison St
Baxley, GA 31513
Phone (912) 367-9847

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760400000000",
    "number": "1558177089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 SUNNYDALE CV",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317574049",
            "telephone_number": "229-520-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUKE",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN245394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.